As a hospital SHO many may think that commissioning is a topic which needn’t concern me. I’m not a GP. I don’t handle the budgets, choose providers or make referrals. This is supported by the fact there has been little literature directed to junior NHS staff. But looking deeper at the issue there are a number of issues which may affect my training, practice and career.

Over the years I’ve heard many complaints that the NHS is run by too many non-clinical managers, rotas being dictated from Europe by people who don’t have to work them and funding of new treatments being withheld on cost basis by those who don’t understand their importance. Surely Commissioning is a step forward, empowering doctors. GPs will have more say about which medications should be funded and where funds should be spent – this can only be a good thing, cant it?

Within the hospital I must gain the necessary experience to one day be the consultant putting forward the name of my establishment as worthy of the GP’s budget. But what if the Commissioning GPs choose to contract to private healthcare providers instead.  Will I lose out of the experience I need, or will the Deanery send me to greener pastures? Withdrawing the trainees, the workhorses of the modern NHS hospital will affect efficiency and may lead to even less work being referred by the GPs, and the cycle continues. Closure of hospitals unable to provide value for money may leave juniors without training posts and patients travelling further for their care.  

What about cross-team referrals? At present, if a patient of mine should require non-urgent input from another speciality, I recommend the GP refer to suggested colleague, whose office is 20 yards down the corridor from mine. That way funding for the next treatment is from the GP, not my department. Will this situation continue with the new Commissioning system – I would expect so.

Saving money by cutting out management, we are promised will save vital funds for clinical priorities. “No redundancies for nursing staff” we are promised, but what about those they expect to lead this revolution, the future GPs and hospital consultants. I understand the BMA are still fighting our corner.

I hope that commissioning will be the “breath of fresh air” that the NHS needs to keep it strong for the next 60 years, but I fear that rushed through and without all parties on side it may widen the rift between primary and secondary care. And where do I stand as a junior? The same place as usual, with no say in the matter and left to weather whatever my seniors decide is right!